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General NPI Number Information
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NPI Number | 1841769791
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Entity Type | Organization
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Legal Business Name | VANTAGE VISION CARE QUAIL SPRINGS, PC
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Dates
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Enumeration Date | 11/21/2018
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 2501 W MEMORIAL RD STE 259A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-8021
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Country | US
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Telephone | 405-847-6739
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 W MEMORIAL RD STE 259A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-8021
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Country | US
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Telephone | 405-847-6739
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANITA D LE
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Credential | OD
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Telephone | 405-847-6739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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